What are the Industry Standards for Credential Verification Organization (CVO) in Health Systems?

Oct 10, 2018

Author: Lisa Rothmuller, Sr. Director of Client Success & Consulting

Health System CVO leaders across the country are looking to share information, identify standards, and understand what others are doing for their health system. Health Systems across the industry are stepping in to lead the conversations.

Verity sponsors a quarterly Virtual Town Hall meeting exclusively focused on Health System CVOs and the unique business needs. The topics are CVO related and often presented by customer sharing their experience and expertise with the group. NAMSS hosted a CVO Symposium for the first time immediately following the national conference this year.

Verity is also hosting a CVO Forum in conjunction with our user conference later this fall. In advance of these important meetings we conducted a CVO-specific survey gathering information to help customers understand what others are doing, where the standards are and what the CVO does can impact their organizations.

Common questions from CVO leaders are related to turnaround time and staffing

How many staff members per file?

How to accomplish our goal turnaround time?

While these questions are not limited to a CVO environment they are frequently asked by health systems consider starting their own CVO.

So, what did we learn from the survey?

In one example, we found CVOs with five FTEs credentialing 2,000-3,000 providers in 31-40 days while another with 3,000-4,000 providers took the same number of days. Why are they different? What could be factoring into these differences?

The answer is most likely in the details. How many years of history does the CVO go back when completing primary source verification for hospital affiliations or malpractice claims history? Is the CVO assisting in gathering privileging criteria?

This insight showed us that the answer to the question about staffing and volume is one that cannot be easily answered. There is no magic formula and the answer is often – well it depends. There are many variables including:

Use of automation and electronic resources

Is privilege criteria gathering part of the process

Timeframe for affiliation and malpractice claims history

The structure for processing files, and many others.

CVO leaders coming together at the NAMSS Symposium, the Verity Thrive Forum and the Verity Town Hall meetings will continue the conversation and education. We hope to see you there!

Looking for a NCQA Certified CVO?

Whether you’re a health plan, surgery center, critical access hospital, LTAC, or any other type of healthcare organization, you can rely on Verity’s NCQA-certified CVO to handle all your initial and re-credentialing files either in an overflow or full-service capacity.